Dentistry for Children in Primary Care Flashcards
Where is the majority of paediatric dentistry carried out and what are the subsections of this?
- general dental service
- independent dentists
- full range of NHS dental care
- PDS
- independent dentists
What details the primary NHS fee structure in Scotland?
- Statement of Dental Remuneration
- SDR
- determination 1
- details 45 treatments on NHS
- previously 700
What does the enhanced preventive advice and treatment plan cover and how often can this be claimed?
- OHI
- TBI and interdental cleaning demo
- food and drink advice
- application of fluoride varnish
- PMPR
- fissure sealants
- SDF
- can be claimed every 3 months
- £19.60
- fissure sealants £12.70 per tooth
- unfilled molars or hypoplastic premolars
- must be within 2 years of eruption
- fee covers maintenance
- high risk patients covered for multiple
- unfilled molars or hypoplastic premolars
What does the primary care NHS fee structure cover?
- provision of orthodontic appliances
- management of dental trauma
- e.g. splint
- sedation
- assessment fee (£37.10)
- sedation (£111.30 per visit)
- supportive preventive care
- supports minimally invasive dentistry
- weighted payments
- SIMD 1 zones
- special care
What are the roles of the GDP for paediatric dentistry?
- management of dental caries
- emergency dental care
- monitoring the developing dentition
- MIH
- orthodontic care
- child protection
What is the role of the GDP for management of dental caries in paediatric patients?
- prevention alone
- cannot just monitor
- biological management
- minimally invasive
- conventional restorative options
- extractions
What is the role of the GDP for emergency dental care in paediatric patients?
- emergency care
- outwit normal working hours
- acute dental problems
- pain
- pulpitis
- abscess
- swelling
- management of dental trauma
What is the role of the GDP for monitoring the developing dentition in paediatric patients?
- important milestones
- 3 years old
- all primary teeth erupted
- 6 years old
- eruption of FPM
- acclimatisation for fissure sealants
- increased mobility of lower centrals
- 9 years old
- palpate crown of upper canines
- buccal sulcus
- 12 years old
- all primary teeth exfoliated OR
- close to exfoliation
- 3 years old
- sequence of eruption
- significant delay
- hypodontia
- ectopic canines
- supernumeraries
- matching lower and upper teeth
- up to 12 months
- matching teeth on either side
- up to 6 months
- significant delay
- developing malocclusions
- IOTN
- severity of malocclusion
- timely assessment for referral
- increased treatment options
- IOTN
What is the role of the GDP in management of molar-incisor hypomineralisation?
- identification
- 2.8%-40.2%
- symptoms requiring management
- hypersensitivity
- crumbling back teeth
- aesthetic concerns surrounding incisors
- management options
- seal
- restore with plastic restoration
- e.g. Fuji triage over affected areas
- PMC
- extractions
- 9/10 years old
- advice from ortho or paeds
- aesthetic management
What is the role of the GDP in orthodontic care in paediatric patients?
- simple orthodontic treatment
- removable appliances
- fixed appliances
- aligners
What is the role of the GDP in child protection in paediatric patients?
- likely to come across a child protection concern throughout career
- useful resources
- Department of Health
- child protection and the dental team
- BSPD
- policy document on dental neglect - RCPCG
- safeguarding children and young people
- Scottish Government
- national guidance for child protection
- Department of Health
What personal factors contribute to caries development?
- poverty
- toothbrushing habits
What oral environmental factors contribute to caries development?
- saliva
- plaque traps
What factors directly contribute to caries development?
- time
- tooth
- bacteria
- dietary carbohydrate
What three sections make up prevention of caries?
- caries risk assessment
- behaviour modification
- tooth protection
What is primary prevention?
preventing the occurrence of disease
What is secondary prevention?
preventing progression of a lesion
What are the 7 components of a caries risk assessment and which is the biggest indicator of caries risk?
- clinical evidence of previous disease
- dietary habits
- oral hygiene habits
- exposure to fluoride
- social history/socioeconomic status
- saliva
- medical history
socioeconomic status is the most relevant caries risk indicator
What factors can affect saliva when considering caries risk assessment?
- diabetes
- xerostomia
- beta 2 angonists/corticosteroid inhalers
- anticonvulsants
- antihistamines
- desmopressin
- acne treatment
What behaviour modification can be carried out to manage caries development?
- attendance patterns
- toothbrushing habits
- use of home fluoride
- drinking and dietary habits
- acclimatisation
What is motivational interviewing?
collaborative, goal-oriented style of communication with particular attention to the lingual of change, designed to strengthen personal motivation
What methods of tooth protection exist for paediatric patients in primary care?
- fluoride varnish
- 22,600ppm sodium fluoride
- 50mg/ml, 5% - every 3 months for high risk
- 22,600ppm sodium fluoride
- fissure sealants
- susceptible molars
- fluoride toothpaste
- can be prescribed from 10 years old
- 2,800ppm sodium fluoride
- 0.619%
- silver diamine fluoride
What is SDF and how does it work?
- silver diamine fluoride
- colourless 38% solution (RivaStar)
- 44,800ppmF
- synergistic effects
- occludes dentinal tubules
- antibacterial
- kills cariogenic bacteria
- fluoride encourages remineralisation
What are the advantages of SDF?
- safe
- simple and quick (5 minutes)
- non-AGP
- non invasive
- evidence based
What are the disadvantages of SDF?
- stains caries black
- temporary tattoo of soft tissues
- relatively expensive (£110 for 1.5ml)
- not in SDR with a service fee
- metallic taste (mask with mint toothpaste)
Why is caries diagnosis more challenging in paediatric patients?
- not ideal clinical conditions
- unpredictable
- anatomical challenges
- small mouths
- larger tongues
- shorter necks
Why might primary molars be more prone to caries development and what are the problems caused by this?
- wider contact points
- hard to spot until caveatted
- larger pulps
- faster spread of caries into the pulp
How should caries diagnosis be carried out for paediatric patients in primary care?
- up to 50% of caries in primary molars can be missed without a radiographic exam
- consider bitewings from age 4
- usually can tolerate
- contacts start to close at this age
- taken at intervals dependent on risk
- 6 months for high risk
- 24 months for low risk
- use paediatric sized films/plates/sensors
- larger can dig in or cause gagging
- consider separators if bitewings not managed
- caries diagnosis possible
- also plan for PMC
What options are available for management of caries in paediatric patients in primary care?
- non-invasive
- biofilm control
- mineralisation control
- dietary control
- requires no barriers to caregivers
- micro-invasive
- sealing
- resin infiltration
- ICON
- minimally invasive
- atraumatic restorative technique (ART)
- effective for single surface lesions
- must be done correctly
- atraumatic restorative technique (ART)
- conventional restorative
- increased risk of pain and anxiety
- mixed
- non restorative cavity control
- self cleansing cavity
- must be close to exfoliation
- must be symptom controlled
- must be infection free
- hall technique
- best survival for occlusal proximal
- quick and easy to place
- must be symptom controlled
- must be infection free
- non restorative cavity control
What is the guidance surrounding use of amalgam in paediatric patients in primary care?
- SDCEP guidelines
- no longer allowed in children under 15
- only used in exceptional circumstances
- not allowed in pregnant or breast feeding
What type of restoration has the greatest longevity in posterior restoration of primary teeth?
preformed metal crowns
What variables must be considered for caries intervention?
- caries risk
- age of child and ability to cope
- length of time until exfoliation
- consider survival rates
- reduce the need for treatment
- choice of material
- ease of use
- survival rate
- minimally invasive considered first
- payment system
Where might a paediatric patient be referred to from primary care?
- PDS
- HDS
- orthodontic services
- non-dental services
Why might a referral be made for a paediatric patient to attend PDS?
- anxiety and phobia
- GA extractions
- sedation
- special needs
- vulnerable groups
Why might a referral be made for a paediatric patient to attend HDS?
- management of severe caries
- medical conditions
- trauma
- dental defects
- multidisciplinary care
Why might a referral be made for a paediatric patient to attend orthodontic services?
- developing malocclusion
- dental anomalies
What non-dental services might a paediatric patient be referred to?
- child protection
- social services
What are the indications for a paediatric patient to receive a general anaesthetic?
- the child needs to be fully anaesthetised before dental procedures can be attempted
- the surgeon needs the child fully anaesthetised before dental treatment can be performed
- only appropriate when there is no other reasonable, acceptable way to restore health and there is significant and prolonged risk of problems arising without treatment
What are the 3 golden rules for treating paediatric patients in primary care?
- effectively manage disease in a way the child can cope
- ensure the treatment plan is achievable for the parent
- promote a positive dental attitude
